Medicare for all, National healthcare by another name.

REMEMBERING THE AFFORDABLE CARE ACT

ARE VOTERS REALLY GOING TO FALL FOR THIS AGAIN?

We hear that healthcare is the number 1 issue in this years election. I remember 10 years ago, the issue was the 30 million uninsured. With the democrats holding both the Senate and House they were able to force through the Affordable care Act without any bi-partisan votes.

Healthcare and insurance has still not recovered. The biggest effect of the ACA was called medicaid expansion which raised the eligibility from 100 % of the poverty level to 130%. Some states opted in, some did not. Many states feared that eventually they would be liable for all the cost.

The people most hurt from the ACA were self employed or those others who paid for their own insurance. Many self employed and small business were driven out of having insurance entirely. The rules of the ACA  mandated what kind of coverage they needed to have. This resulted in the policies they had for years, many of which they were happy with, being cancelled. Many simply could not afford what was now being offered. It seemed it was an attempt to force people into ACA policies.

The lower priced policies of the ACA often had deductibles in the 6 to 10 Thousand dollar area, co-pays as high as 40%. Economically it was a bad deal. Many choose to go without. Then they were hit with a fine for not having insurance. I know of people who had 3 or 4 policies canceled within 2 years. They then needed to look for replacements, which often were in a different group, with different doctors etc.

Medicaid expansion was coupled with cuts in reimbursements. Many doctors began to refuse to see Medicaid people because they could actually loose money by treating them. Often reimbursements could not buy 2 burger king meals.

Money was taken from Medicare to pay for the implementation of the whole scheme. 

One part of the ACA was not being denied for insurance for pre-existiing conditions. Another was you keep children on your policy till age 26. You could always keep your kids insured to age 26, you just had to pay the premium. It was reasonable.

Another group that was hurt was young adults. I insured my son while in college. It cost around $100. a month with a $1000 deductible and a 80-20 co-pay. a normal policy at the time. After ACA, insurance companies were no longer allowed to use actuary tables which allowed the young to pay little as they used little. Your premiums increased as you aged. Many of the premiums for young adults increased by 500%.

Those whose insurance is paid for by their employer saw their co-pays increase dramatically, as all policies  increased in cost.

Worst part is, according to the Kaiser foundation, there were still 27.6 million uninsured at the end of 2016. So the number of uninsured hardly moved, but it is different groups without insurance.

Before the ACA most people believed we had the best healthcare in the world, they just wanted relief from the rapidly increasing cost.

So here we are in 2018 and the democrats are attempting to scare people by stating that the republicans are going to stop the pre-existing condition  part of ACA. What they mean is Republicans may be going to repeal ACA which has been a disaster for most of America.

The Republicans have stated they had provisions to insure that people would always be able to have insurance.

The individual mandate has been repealed, as it should have been. Insurance companies are now offering policies that are not dictated by the ACA. although they are not in compliance with the law.

A law was recently passed that required advertisement of drugs to publicize the cost of drugs, so that consumers could decide and market forces would cause competition and a lowering of the cost of drugs.

An incremental market based approach to lower the cost of health care is the best approach to have quality affordable healthcare. 

The new buzzword is Medicare for all. This is National healthcare. Such a plan would eliminate private insurance, eliminate self-employed doctors. Everyone in the healthcare industry would work for the government. Many decisions about healthcare would be made by bureaucrats. Most likely patients would have few choices. The cost would be paid for by an increase in federal taxes as high as doubling your taxes. While all these results would not possibly be immediate they would in time be implemented.

At present, both Medicare and Medicaid are in effect being subsidized by increased cost on the private insurance market. Doctors and Hospitals have been shifting costs to their insured patients to offset the low reimbursement from Medicare and especially Medicaid. Without private insurance in the market much of the healthcare system will implode.

It is very likely service would deteriorate, quality of care would decline, all in the quest of realizing some ideological goal. We need to focus on results not on achieving ideological goals.

Is this a gamble that the country should be willing to take? Once this system is completely eliminated, we will never be able to reconstruct it.


originally published 10/31/18.

The above facts still apply.  All the democrat candidates want some form of national healthcare. They claim that replacing insurance companies will cut costs. The reality is that the insurance company workers will just be replaced by Government bureaucrats to administer healthcare.  The focus should be in lowering the cost of medical care. Things like advertising prices for procedures, guarantees for results. 1 common claim form, expedited payments to providers. This would be a start. These reforms need to be made with consultation with providers, not by government mandates.

The focus should be to reduce costs for everyone including the providers.